Abstract
Introduction: Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in patients are hard to treat and cause high morbidity and mortality. ESBL-producing bacteria have been increasingly detected in environmental samples in different countries since 2002, and have gained considerable attention worldwide.Methods: Antibiotic susceptibility of all isolates was determined using the disk diffusion method. The production of ESBLs was determined by the double-disk synergy test.Results: Among the outpatient clinical samples, out of 2857 Gram-negative bacteria, 184 (6.5%) ESBL-producing bacteria were isolated. In this group, 143 (77.7%) were from urine samples, 26 (14.1%) from surgical wounds, 6 (3.3%) from umbilical swabs, and 9 (4.9%) from other patients sites (upper respiratory tract, cannula, eyes, genital swabs). Escherichia coli was isolated in 62 (33.7%), and Klebsiella spp. in 50 (27.8%) cases. Among the environmental samples, out of 381 Gram-negative bacteria, 52 (13.6%) were ESBL-producing isolates. In this group, 37 (71.2%) were sampled from water, 7 (13.5%) from food, and 8 (15.4%) from environmental surfaces. The most prevalent ESBL-producing bacteria isolated from the environmental samples were E. coli (isolated from 26 samples), Klebsiella spp. (10), non-fermenters (9), and other bacteria isolated from 7 samples. The clinical outpatient ESBL-producing isolates showed resistance to all cephalosporins, ranging from 25% (cefepime) to 100% (cefuroxime). The environmental ESBL-producing isolates showed resistance to cefuroxime, aztreonam, cefpodoxime, amoxicillin/clavulanate, and cefoxitin in the range of 65-100%.Conclusions: Prevalence of antibiotic resistance of ESBL-producing strains is high and requires routine detection of ESBL-producing isolates in the laboratories, designing of appropriate antibiotic prescribing policies and control of the risk factors.
Highlights
Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in patients are hard to treat and cause high morbidity and mortality
ESBLs are plasmid encoded enzymes and their genes are usually transported by plasmids
The enzymes are capable of inactivating a large number of beta-lactam antibiotics, including an extended spectrum and a very broad spectrum cephalosporins and monobactams
Summary
Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in patients are hard to treat and cause high morbidity and mortality. Antimicrobial resistance has been recognized as an important global health problem in many fields, such as human and veterinary medicine, livestock holdings, agriculture, and environment [1,2]. The production of extended-spectrum beta-lactamases (ESBLs) or AmpC beta-lactamases is one of the most important mechanisms of resistance to extended-spectrum cephalosporins in the Gram-negative isolates [4]. The enzymes are capable of inactivating a large number of beta-lactam antibiotics, including an extended spectrum and a very broad spectrum cephalosporins and monobactams. The overexpression of chromosomal or plasmid-mediated AmpC enzymes in patients can cause resistance to broad spectrum cephalosporins [5]
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